Endoscopic vs Open-Neck Zenker Diverticulum Surgery

Abstract

Objective: Compare long-term symptomatic outcomes between open-neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker diverticulum.

Method: Patients at least 1 year after surgery for Zenker diverticulum were telephoned and questioned of dysphagia, choking, regurgitation, and halitosis based on a validated Gastrointestinal Quality-of-Life Index. Symptom degree preoperatively and at phone call was assessed. Patients rated their overall postoperative symptoms as worsened, unchanged, improved, or completely resolved.

Results: A total of 55 of 102 patients were contacted. Of these, 24 underwent ESD and 31 had open-neck procedures. Average follow-up time was longer for the open-neck group (5.7 vs 3.1 years, P < .01). Gender, age at operation, diverticulum size, and preoperative symptom scores were not statistically different between the 2 groups. For both techniques, symptom scores showed significant improvement postoperatively (P < .01). A greater proportion of patients undergoing open-neck procedures reported their symptoms to be completely resolved or improved (93% vs 67%, P = .015). Specifically, complete resolution of symptoms was achieved more often in those who had open-neck surgery (77% vs 50%, P = .047).

Conclusion: Both the open neck and ESD surgeries significantly benefit patients, regardless of diverticulum size. Long-term symptomatic outcomes between the 2 populations indicate that patients with open-neck procedures attain a greater degree of resolution of preoperative symptoms. This may be due to fundamental differences between the surgical techniques.